Central Line Care Key to Less Pediatric Blood Infections

Last Updated: January 13, 2010.
In pediatric intensive care units, central line maintenance practices have the biggest impact on reducing catheter-associated bloodstream infections, according to a study published online Jan. 11 in Pediatrics.

Pediatric intensive care unit practices must differ from those in adult units

Marlene R. Miller, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a study of 29 pediatric intensive care units using two central venous catheter-care practice bundles -- one insertion bundle derived from adult bloodstream infection prevention practices, and a maintenance bundle based on expert pediatric clinician consensus. Compliance with the bundles was monitored from 2006 to 2007, and the rate of catheter-associated bloodstream infections was monitored from 2004 to 2007.

There was an average 43-percent reduction in catheter-associated bloodstream infections, from 5.4 to 3.1 infections per 1,000 central-line-days, and compliance reached 84 percent for the insertion bundle and 82 percent for the maintenance bundle by September 2007, the researchers found. Use of the insertion bundle alone did not reduce the overall risk of catheter-associated bloodstream infections, the investigators note.

"Instead, the main driver for additional reductions in pediatric catheter-associated bloodstream infection rates seems to involve issues surrounding daily maintenance care for central lines, as defined by our maintenance bundle," the authors write. "Additional research is still needed to determine the optimal maintenance bundle that will facilitate elimination of catheter-associated bloodstream infections in all children who require short- or long-term central venous access."